Michelle J. Hindin

The mistreatment of women during childbirth in health facilities globally: A mixed-methods systematic review

Background Despite growing recognition of neglectful, abusive, and disrespectful treatment of women during childbirth in health facilities, there is no consensus at a global level on how these occurrences are defined and measured. This mixed-methods systematic review aims to synthesize qualitative and quantitative evidence on the mistreatment of women during childbirth in health facilities to inform the development of an evidence-based typology of the phenomenon. Methods and Findings We searched PubMed, CINAHL, and Embase databases and grey literature using a predetermined search strategy to identify qualitative, quantitative, and mixed-methods studies on the mistreatment of women during childbirth across all geographical and income-level settings. We used a thematic synthesis approach to synthesize the qualitative evidence and assessed the confidence in the qualitative review findings using the CERQual approach. In total, 65 studies were included from 34 countries. Qualitative findings were organized under seven domains: (1) physical abuse, (2) sexual abuse, (3) verbal abuse, (4) stigma and discrimination, (5) failure to meet professional standards of care, (6) poor rapport between women and providers, and (7) health system conditions and constraints. Due to high heterogeneity of the quantitative data, we were unable to conduct a meta-analysis; instead, we present descriptions of study characteristics, outcome measures, and results. Additional themes identified in the quantitative studies are integrated into the typology. Conclusions This systematic review presents a comprehensive, evidence-based typology of the mistreatment of women during childbirth in health facilities, and demonstrates that mistreatment can occur at the level of interaction between the woman and provider, as well as through systemic failures at the health facility and health system levels. We propose this typology be adopted to describe the phenomenon and be used to develop measurement tools and inform future research, programs, and interventions.

Who's at risk? Factors associated with intimate partner violence in the Philippines.

We describe the individual and household characteristics associated with intimate partner violence (IPV) in the Philippines, using data from the Cebu Longitudinal Health and Nutrition Survey (CLHNS). We also examine 56 in-depth interview transcripts to explore the context of IPV. We focus our analysis on patterns of household decision-making as a measure of the interpersonal dynamics between husbands and wives. Thirteen percent of women in our sample reported IPV. While economic factors are often implicated in the cycle of violence in households, we find employment status and relative earnings do not predict IPV. Lower levels of household wealth and urban residence are associated with a higher likelihood of IPV. Patterns of household decision-making emerge as strong predictors of violence. The greater the number of decision-making domains men dominate, the more likely they are to use IPV; however, we also find that when women dominate household decisions, they are also more likely to experience IPV. Only 6% of women reported IPV when all household decisions were made jointly compared to 25% when no decisions were made jointly.

Cohort Profile: The Cebu Longitudinal Health and Nutrition Survey

The Cebu Longitudinal Health and Nutrition Survey (CLHNS) was originally conceptualized as an interdisciplinary study of infant-feeding patterns, particularly the overall sequencing of feeding events (milks and complementary foods), the factors affecting feeding decisions and how feeding patterns affect the infant, mother and household. The idea was to study these topics within as natural a setting as possible and to analyse how infant-feeding decisions interacted with social, economic and environmental factors to affect health, nutritional, demographic and economic outcomes. The study was subsequently expanded to cover a wide range of maternal and child health and demographic issues that could be well studied using a prospective, community-based sample. The study was initially the product of collaboration among researchers at the Carolina Population Center at the University of North Carolina at Chapel Hill (led by B.M.P. with J.S.A. and D.K.G.), The Office of Population Studies Foundation at the University of San Carlos in Cebu, Philippines (led by the late Director Wilhelm Fleiger) and the Nutrition Center of the Philippines (led by Florentino Solon). L.S.A. took the lead for follow-up surveys beginning in 1990. Later, the study team was expanded to include researchers presently at the Northwestern University (C.W.K. and T.M.D.) and Johns Hopkins University (M.J.H.). The study was initiated with cooperation and approval from the Cebu Department of Health. The CLHNS website includes a full list of investigators and their affiliations. The CLHNS was one of the first large-scale, population-based surveys designed with a conceptual framework in mind. The guiding framework was adapted from Mosley and Chen’s health determinants model, which posits that underlying community-, householdand individual-level variables affect a set of proximate health behaviours which, in turn, influence health outcomes such as growth and infectious disease morbidity and mortality. The study was designed by a highly interdisciplinary group of economists, sociologists, nutritionists, demographers and physicians. The CLHNS has been funded by a large number of government and non-government organizations (listed in the Funding section).

Understanding women's attitudes towards wife beating in Zimbabwe

OBJECTIVE To investigate the factors associated with attitudes towards wife beating among women in partnerships in Zimbabwe in order to assist public health practitioners in preventing intimate partner violence (IPV). METHODS A nationally representative survey of 5907 women of reproductive age (15-49 years) was conducted in Zimbabwe. Women were asked about their attitudes towards wife beating in five situations. The survey included sociodemographic characteristics, partnership characteristics, and household decision-making. FINDINGS Over half of all women in Zimbabwe (53%) believed that wife beating was justified in at least one of the five situations. Respondents were most likely to find wife beating justified if a wife argued with her spouse (36%), neglected her children (33%), or went out without telling her spouse (30%). Among women in partnerships (n=3077), younger age, living in rural areas, lower household wealth, schooling at a lower level than secondary, and lower occupational status were associated with women reporting that wife beating is justified. Women who reported that they make household decisions jointly with their partners were less likely to say that wife beating is justified. CONCLUSIONS Zimbabwe has a long way to go in preventing IPV, particularly because the younger generation of women is significantly more likely to believe that wife beating is justified compared with older women. Given the current social and political climate in Zimbabwe, finding means to negotiate rather than settle conflict through violence is essential from the household level to the national level.

Formal and informal help-seeking associated with women's and men's experiences of intimate partner violence in Canada

While numerous studies have documented the prevalence, correlates, and consequences of intimate partner violence (IPV); most of this research has used a criminal justice framework that has focused on acts of physical violence. However, critics argue that this narrow conceptualization of IPV belies the heterogeneity in this experience with respect to the nature of coercive control in the relationship. Moreover, they contend that the different types of abusive and controlling relationships not only have a different etiology, health consequences, and help-seeking characteristics, they also have a different relationship by gender. This study examined the extent to which different patterns of violence, abuse, and control were differentially associated with formal and informal help-seeking in a national Canadian sample. Data from the 2004 General Social Survey were analyzed, which included 696 women and 471 men who reported physical or sexual violence by a current or ex-spouse or common-law partner. The most commonly reported formal sources for women and men were health professionals (i.e., doctors, nurses, counselors, psychologists) and the police. For women, informal sources (i.e., family, friends, neighbors) were commonly reported across all IPV subgroups. However, the importance of almost all of the formal sources (e.g., health professionals, police, lawyers, shelters, crisis centers) increased as the severity of the violence and control increased. Shelters and crisis centers were also reported by a notable proportion of women who experienced the most severe pattern of violence and control. For men, both formal and informal sources were more commonly reported by those who experienced moderate violence and control compared with those who experienced relatively less severe acts of physical aggression. The results suggest that research that more sensitively examines peoples experiences of violence and control can help identify their health, social, and safety needs; and ultimately better inform the development of programs and services aimed at addressing these needs.

The prevalence of maternal near miss: a systematic review

Please cite this paper as: Tunçalp Ö, Hindin MJ, Souza JP, Chou D, Say L. The prevalence of maternal near miss: a systematic review. BJOG 2012;119:653–661.

Adolescents and Youth in Developing Countries: Health and Development Issues in Context.

Adolescence is a period of transition, marked by physical, psychological, and cognitive changes underpin by biological factors. Todays generation of young people - the largest in history - is approaching adulthood in a world vastly different from previous generations; AIDS, globalisation, urbanisation, electronic communication, migration, and economic challenges have radically transformed the landscape. Transition to productive and healthy adults is further shaped by societal context, including gender and socialisation process. With the evidence that young people are not as healthy as they seem, addressing the health and development issues of young people, more than ever before, need concerted and holistic approach. Such approach must take the entire lifecycle of the young person as well as the social environment into context. This is particularly critical in developing countries, where three major factors converge - comparatively higher proportion of young people in the population, disproportionately high burden of youth-related health problems, and greater resources challenge.

Changing men's attitudes and behavior: the Zimbabwe Male Motivation Project

A multimedia communication campaign was conducted between 1988 and 1989 to promote family planning among men in Zimbabwe. The campaign consisted of a 52-episode semiweekly radio soap opera, about 60 motivational talks, and two pamphlets about contraceptive methods. Changes over time were measured by comparing a subset of a follow-up survey conducted from October to December 1989 to a baseline survey conducted from April to June 1988. Men exposed to the campaign were also compared to men who were not exposed. The follow-up survey revealed that the campaign reached 52 percent of men aged 18 to 55. Among married Shona-speaking men, use of modern contraceptive methods increased from about 56 percent to 59 percent during the campaign. Condom use increased from about 5 percent to 10 percent. Awareness and current use of modern contraceptives was also higher among men exposed to the campaign, primarily because of their greater awareness of condoms. Men exposed to the campaign were significantly more likely than other men to make the decision to use family planning and to say that both spouses should decide how many children to have.

Psychosocial Consequences of Intimate Partner Violence for Women and Men in Canada

Although the negative health consequences of intimate partner violence (IPV) are well documented, most research has conceptualized IPV as a unitary construct and has primarily focused on the impact of physical violence. However, recent theoretical and empirical work suggests that IPV may be heterogeneous, with different consequences associated with different patterns of violence, abuse, and control. This study used latent class analysis to examine the psychosocial consequences associated with different patterns of physical violence, sexual coercion, psychological abuse, and controlling behavior. Data from 676 women and 455 men who were interviewed for the 2004 Canadian General Social Survey on Victimization were analyzed. The results suggest that experiencing any pattern of violence is associated with a range of negative psychosocial outcomes for both women and men. However, they also show the increasingly negative impact and perceived dangerousness of IPV for those experiencing more severe and chronic patterns of violence and control. These findings were particularly pronounced for women as they experienced the most chronic pattern of abuse and control documented in the study. The psychosocial consequences were also greater for women than for men with similar experiences of IPV. These results suggest that the psychosocial impact of IPV is influenced by gender and by the nature of the violence, abuse, and control experienced.

Exploring gender differences in the patterns of intimate partner violence in Canada: a latent class approach

Background There has been an ongoing debate about the extent and nature of gender differences in the experience of intimate partner violence (IPV). Disagreement about the appropriate definition of IPV is central to this debate. Methods This study used latent class analysis (LCA) to map the patterns of physical violence, sexual coercion, psychological abuse and controlling behaviour, and examined whether LCA can better illuminate the gendered nature of this experience than conventional measures of IPV. Data from the 2004 Canadian General Social Survey were analysed, which included 8360 women and 7056 men 15 years of age and over who reported a current or ex-spouse or common-law partner. Results Results revealed more variation in the patterns of IPV for women than for men. Six classes were found for women, whereas four classes were found for men. Women and men were equally likely to experience less severe acts of physical aggression that were not embedded in a pattern of control. However, only women experienced a severe and chronic pattern of violence and control involving high levels of fear and injury. For women and men, intermediate patterns of violence and control, and patterns describing exclusively non-physical acts of abuse were also found. The results also revealed substantial differences in the IPV subtypes for those reporting about a current versus an ex-partner. Conclusion These results support the use of LCA in identifying meaningful patterns of IPV and provide a more nuanced understanding of the role of gender than conventional measures. Implications for sampling within IPV research are discussed.